Hi guys! I’m back with my Med Life Series. A few years back, I talked about my clerkship chronicles, that is equivalent to 4th year in post-grad in medical school, which you can read about here. Today, I’ll be dwelling with the internship series! This is the time when you get matched to one hospital that you will be rotating in for a year. I was fortunate to get into the hospital I loved to get into which is Veterans Memorial Medical Center. The first time I stepped into the corridors of VMMC, I was so sure that I’d want to work in there for internship, so having the opportunity to get into that hospital was really the best!
For the first stop, it’s Pediatrics. I love Pediatrics! It’s one of the subjects that I get by with full enthusiasm due to the fact that I got the chance to be tutored by one of the best Pedia doctors I have encountered during my clerkship life (Hello Doc Tabije!) Yep, he’s from my alma mater, FEU-NRMF, and the way he taught things for us, especially my duty team, was really effective. I admire how passionate he is when it comes to discussing each case, and why we do this and that, give this and that, etc.
So going on… how do you really survive Pediatrics? Well, like all rotations, I suggest that you get a general grasp of what you should be doing initially, that is your general attitude towards internship. If you haven’t read my article about The Essential Guide to Medical Internship, head on to that first, then go back here to learn the specifics! 😉
Pedia is a Different World
In Pedia, it’s like a 2-in-1 coffee sachet. You get a pediatric patient? You also get a guardian with you. Of course, the only way for you to interview a 5-month old baby is to ask questions to the guardians/parents first. That being said, it’s quite different when you interview pediatric patients.
You ask the patient indirectly by depending on what the guardians would say… well that would be the case if the patient can’t talk to you. But if the patient can already talk, there will be times that they cannot fully articulate what’s going on with their body compared to a full-grown person who can even tell you all the adjectives associated with the pain he or she might feel on the right lower quadrant for instance. So yea, pedia is a different world, but it’s different in a good way.
Once you get your style of asking questions, back and forth to the patient and the parents/guardians, and once you fully know how you can probe that answer out, you will get by it. More so, signs and symptoms of a pedia patient can be quite different compared to the adult. That is why, I suggest that you invest in pediatric books or references. Although there will be similarities in some guidelines, the cut-offs in the laboratory, the dosage of medicine to be given, the must-know signs and symptoms for every case, etc, can also be different.
Get Your Calculators Ready
As I’ve said, dosage of medicines will be different. For every change in age or for every change in weight, depending on the therapeutic dosage (TD) of a medicine, prescribed dosages will be different. This was like one of the hazy parts when I first encountered a “TD”. When I was a clerk, my residents would ask me if I know the TD of a drug, etc., and I just stare back at them like a puppy internally asking “what in the world is a “TD”? but after teaching me about it, I finally saw the light (Thank you , docs!)
This will come in handy once you get to the clinics after internship. I got to learn this part in clerkship, so if you already know this, then just refresh it from your memory. If you are new to this concept, just ask your colleagues about it. There is a computation for that, a formula that can be used to get you to the right TD, and double check it with another formula afterwards.
Know Your Vaccines
You will NEED THIS. It’s a skill to actually know everything in the vaccination chart. And you have no choice but to familiarize or even memorize the chart. For instance, ask yourself… what vaccines should have been given to a one year old and how many per vaccine should have been completed by that time? By 4 years old? By 9 years old? And so on. I’m gonna be honest, I still forget the scheduling sometimes. I get question marks in my head whenever I try to remember all of these, especially if I don’t get much of pedia patient after 5 months or so. But that’s fine, for as long as you REMEMBER to ASK ABOUT IT.
It’s better if you also have your Pedia reference with you all the time. That way, you can just get a quick glance of your notes and prevent too much delay in the interview. I suggest that you read about the Expanded Program for Immunization in the Philippines. Learn the scheduling, because that matters. For every patient you get to interview, you must know their history together with their vaccination history. It’s a must.
Be Inquisitive, Really Inquisitive
Have you ever asked a guardian about how the baby bottles are being washed? Or how much breast milk the baby would intake for a span of 24 hours and in what frequency? Sometimes, the tiniest parts of the interview will change the way you will see things in your patient’s case. The way a bottle is washed can be a supporting factor for the reasons why the baby is having a gastroenteritis, or the reason why a baby is having jaundice is because of not enough milk. You see, these questions can be thought to be unimportant for some, BUT THESE ARE IMPORTANT. Ask like a detective. Because in those small details will be gems of answers. And those answers will lead you to the proper management.
At the end of your rotation, I hope you get in-love with Pediatrics Wonderland. There’s so much to learn in Pedia, and it can be overwhelming in the beginning. But in any kind of work, you will get used to it. Just set your facts straight. Read, read, and read. Delineate differences, take notes, calculate your way to your medicines, remember the vaccination chart, get a milestones checklist, ask a LOT of questions, be proactive, play with the kids, know the guardians, know their histories, know their stories. 🙂
Have comments and stories to tell? I’d love to hear from you!